Blog Details

Telehealth Medical Claim Denials

 Six Tips to Avoid Telehealth Claim Denials

Reading Time: 3 minutes

The pandemic brought with it a shift in how medical care is carried out. Due to the fear associated with catching COVID 19, the rules surrounding telehealth were relaxed. As a result, it brought telehealth to the forefront, and providers were able to care for their patients even through the stay-at-home orders and social distancing mandates.

With telehealth becoming a growing topic for providers, payers, patients, and the overseeing governmental agencies, attention needs to be paid to ensuring that providers are getting reimbursed correctly.  Research shows that by 2020 there will have been an estimated 158.4 million telehealth video sessions compared to just 19.7 million in 2014.  Even with the relaxation of rules and regulations around telehealth services the billing process can be complex as the guidelines are constantly changing and will more than likely change again once the public health emergency has been lifted.

There are several things providers should do to ensure they are filing telehealth medical claims correctly:

  1. Verify exact coverage – Medicare has listed the services covered under the Medicare Physician Fee Schedule however, not all commercial payers follow this list. Your best option is to call and verify each payer’s telehealth policy to ensure it is covered. Questions to ask could include:
    • What telemedicine health care services can be done?
    • Is live video telemedicine specifically covered?
    • Are there limits on the total number of telemedicine visits the patient may have each year?
    • Are there conditions that must be met, or restrictions, before patients qualify to be covered for telemedicine services? (Ex: established patient vs new patient, patient consent in writing, specific distance from provider)
    • What are the specific CPT codes that are considered payable when services are provided via telehealth?
  1. Documentation requirements – Although most payers are required to cover telehealth visits at the same or similar rate as in-person visits, they may have different requirements on how to document the visit so it is important to research each payer’s guidelines.
  2. Accuracy in coding – Unfortunately, not all payers follow the same rules, so like with your standard in-office billing, you must be diligent and understand what code is appropriate when billing for telehealth.
  3. Make a list – Compile a list of all payers along with any specific requirements for POS codes or additional documentation. Having this at hand can help to ensure you are coding claims correctly thus lessening the opportunity for a claim denial.
  4. Monitor denials – Like with all denials, monitoring telehealth claim denials will allow you to avoid continuing to make the same mistake or give you a heads up that a payer has changed their policy. Denials may be the only way that you know if something has changed. Also, should a claim be denied, make sure you file a timely appeal to ensure you don’t lose revenue.
  5. Keep up – Things are changing rapidly and therefore require you to stay informed on any new rules, regulations, or laws pertaining to telehealth services.

 

As telehealth becomes more utilized we can hope that a set of clear guidelines and rules will get adopted across payers. Until then being vigilant through the entire telehealth billing process is what it will take to ensure correct and timely reimbursement.

Technology advances are happening daily and the demand for flexibility and convenience is growing. The benefits of telehealth and telemedicine will continue to increase and remain an integral part of healthcare, which is good news for patient outcomes, care continuity, and chronic care management.

How Billed Right Can Help

With the ever-changing landscape, it is important to have someone who is keeping up with the new rules and guidelines. That is where Billed Right comes in. As a strategic partner, focused on ensuring that your medical billing is done correctly and on time, utilizing our revenue cycle management services can take the burden off your staff.  We employ AAPC certified coders and experienced medical billers to ensure we maximize your revenue potential and keep you educated and updated along the way.

Contact us today to learn more about how outsourcing your medical billing with Billed Right gets you a strategic partner focused on growing your business and optimizing your operational management.

Have Questions?
Call Now for Assistance